Sunday, March 22, 2020

Breaking finding: Check for lymphopenia on day 1, 7 and 14 in COVID 19 patients

Check for lymphopenia on day 1, 7 and 14 in COVID 19 patients

Dr KK Aggarwal
President CMAAO, HCFI and Past national president IMA

Dengue taught us the value of platelet count interpreted along with haematocrit and COVID 19 is now teaching us the value of lymphocytes in blood test.
It has been a standard teaching that all viral fever will have high lymphocytes counts. Low count will only occur with HIV, SARS like illness, measles and hepatitis.

Now all studies have shown it to be an important marker of COVID 19
In the latest study published in March 9, 2020, the Lancet, the authors showed that baseline lymphocyte count was significantly higher in survivors than non-survivors; in survivors, lymphocyte count was lowest on day 7 after illness onset and improved during hospitalisation, whereas severe lymphopenia was observed until death in non-survivors.

Clues for COVID-19 include leukopenia, seen in 30% to 45% of patients, and lymphocytopenia, seen in 85% of the patients in the case series from China,

Other associated lab findings are elevated alanine aminotransferase and aspartate aminotransferase levels (37%).

High D-dimer levels and more severe lymphopenia have been associated with mortality.

1.     Chen N, Zhou M, Dong X, Qu J, Gong F. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Jan 30. [Epub ahead of print]
2.     Li Q, Guan X, Wu P, Wang X, Zhou L, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Jan 29.

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